Healthcare Provider Details

I. General information

NPI: 1912132010
Provider Name (Legal Business Name): IAN RUSSELL ROWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W. EIGHTH ST. CLINICAL CENTER, 1ST FLOOR
JACKSONVILLE FL
32209
US

IV. Provider business mailing address

655 W. EIGHTH ST. BOX C506 CLINICAL CENTER, 1ST FLOOR
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-3837
  • Fax: 904-244-4508
Mailing address:
  • Phone: 904-244-3837
  • Fax: 904-244-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberTRN13706
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME112301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: